ANYONE WHO DOUBTS that, at least from the cultural point of view, the Soviet Union won the Cold War in Britain hands down should attend a conference organised for doctors about impending organisational changes in the National Health Service (and organisational changes are always impending in the NHS).

There he will be convinced that every doctor will soon have a political commissar working alongside him to remind him of his wider responsibilities to government and party.

Doctors in Britain are now roughly in the position of Tsarist generals, scientists and ‘specialists’ in the first phase of the Russian Revolution: necessary but distrusted, hated and feared, and to be eliminated altogether as soon as possible.

The British revolution, however, has been carried out neither by the proletariat nor in the name of the proletariat: it is, rather, the revolution of the ambitious but ungifted, of whom there is a gross oversupply.

For everyone is persuaded these days that there is only one thing worth having, and that thing is power.

Last week I attended, for the sheer fun of it, a conference about some forthcoming changes to the NHS.

One of the lectures was given by a lady apparatchik from the Department of Health whose grimacing attempts at smiles, and whose bodily writhing as she tortured the English language with neologisms, acronyms and platitudes in the service of evident untruth, made Gordon Brown’s bonhomie seem like a model of spontaneity.

She knew what the assembled doctors thought of her, so in a sense she was being brave; at one point in what I suppose I must call her ‘presentation’ there was a single guffaw of contemptuous laughter.

It was an illuminating moment, a flash of lightning in a moonless night-time landscape.

For a moment I felt almost sorry for the speaker: you could see the panic on her face, a fear lest a hundred and fifty doctors turn on her and demand explanations in comprehensible language.

Alas, doctors are far too well brought up and chivalrous (or is it pusillanimous?) to humiliate an ambitious dimwit in public; and so the ambitious dimwits live to plot their revenge and increase their power.

Once in the Equatorial Guinean capital of Malabo I spent a very happy afternoon counting the number of aid agencies whose white Land Cruisers passed me in the street (the only vehicles there were).

I counted twenty-seven agencies in all, which goes to show that corrupt dictatorships are the boon of aid agencies.

And I had a friend who played a game of special cricket in his mind whenever he was in the company of an eminent but notoriously self-obsessed colleague.

A run was scored every time the colleague said ‘I’; there was a wicket whenever he uttered a sentence without mentioning himself. Needless to say, no innings was ever completed.

In like fashion, I spent the conference counting the acronyms.

I may have missed a few after lunch, when my stomach was full of soggy quiche and a banana.

The best acronyms, of course, should provide no clue as to their meaning, and yet be bandied about as if the meaning were known to all. Once their meaning is known to all, however, their bureaucratic utility declines: for acronyms are to modern bureaucrats what incantations are to ancient shamans.

British slang converter for overseas readers:

Not so much a slang conversion, actually, but a brief explanation of Dalrymple’s cricketing metaphor.

Cricket is played between two teams of eleven, each taking it in turns to bat while the other bowls.

The aim of batting is to score as many ‘runs’ – almost but not quite analogous to points – as possible.

The aim of bowling is to dismiss each batsman (‘get him out’, or ‘take his wicket’), in order that he retires from the field and can score no more runs.

Each innings has ten wickets (one batsman is left ‘not out’ at the end); thus, when Dalrymple writes that ‘Needless to say, no innings was ever completed’ he means that a sentence lacking the word ‘I’ was uttered fewer than ten times.

Like this:

WHO HATH WOE? who hath sorrow? who hath contentions? who hath babbling? who hath wounds without cause? who hath redness of eyes?

No prizes for guessing the answer: they that tarry long at the wine, of course, especially what the Bible calls ‘mixed wine’, the ancient equivalent of our White Lightning and Special Brew snakebite.

The current favourite among the park-benchers, if I may so call them, is 8.4 per cent cider, an appalling liquid which comes in two- and three-litre bottles known technically as ‘rubber ducks’.

‘Why are they called that?’ I asked a patient who belonged to the park-bench culture.

‘I don’t really know. It’s because they float in the bath or the pond, I suppose.’

‘Not with two or three litres of cider in them.’

‘But they never have two or three litres in them for long.’

True enough: I’ve seen many a rubber duck in the gutter, but never a full one.

‘And when did you last work?’ I asked.

He screwed up his eyes and scoured his brain, like an archaeologist scratching around in the sand for traces of remote antiquity.

‘1976,’ he said, after much delay.

‘How have you kept yourself since then?’

‘I’ve been on the Sick.’

‘What illness?’

‘Drink. It’s not that I’m stupid, doctor, it’s just that I’m addictable.’

A sudden happy thought came to him, like a mitigating circumstance after an unexpected verdict of guilty.

‘I did do a bit of work, though, for a couple of weeks.’

‘Where?’

‘In this factory. Only I couldn’t do it for long, I kept getting nervous and shaking in the morning and being sick.’

‘So either the work or the drinking had to go, and you chose the work?’

‘Well, I didn’t know about the morning drink in those days, doctor.’

Happily, his knowledge of morning drink had increased since then.

He lived with an alcoholic woman – ‘one of the best pianists in the country, doctor, when she’s sober’ – and together they rose early.

‘We wake up and start drinking at 5 o’clock in the morning.’

‘I suppose it’s a question of the early bird catching the vermouth. And why did you come to hospital?’

‘It was my doctor who sent me. His name abates me. He said I had no blood in me. I said it wasn’t because I cut my wrists or anything, it must be because I keep throwing it up.’

He shook his head sorrowfully.

‘To tell you the truth, doctor, the drinking is abysmal.’

‘Are you sure it’s the drinking that’s abysmal?’ I asked.

‘Of course, it doesn’t help that she’s an alcoholic too. She’s a lovely woman, but put a drink in her and it’s like playing with a snake.’

‘Are you violent towards her?’

‘Yes, but it’s six of one and half a dozen of the other. She beat me up on video once, it’s humiliating, me being a bloke and all that.’

‘And are you going to stop?’

‘Well, I’ll have to, doctor. I mean when you’re drinking it’s just one long, boring, grinding day after another.’

‘Unlike being at work,’ I said.

Old Isaiah was right after all: woe unto them that rise early in the morning, that they may follow strong drink; that continue until night, till wine inflame them!

British slang converter for readers from overseas:

‘Snakebite’– a mixture of cider and lager, said to produce violent outbursts in those who drink it (and awe-inspiring hangovers). ‘White Lightning’ was a brand of very strong cider, first reduced in alcohol (from 8.4% to 7.5%, and then 5.5%) and finally discontinued in 2009 as a brand because of its association with alcoholism. Carlsberg Special Brew is a very strong lager, 9% abv, originally brewed to commemorate a visit to Denmark by Winston Churchill in 1950.

Then the doctor examines him and perhaps performs some laboratory or other tests.

Finally, having arrived at a diagnosis, the doctor applies the correct treatment, be it pharmacological or surgical.

From the purely abstract point of view, it is all rather simple and straightforward.

In practice, however, complications sometimes arise.

For example, last week there was a patient in my ward who told me that he had been off sick from work for the past year.

‘With what sickness?’ I asked.

Normally in these circumstances this question produces puzzlement, as if it were a complete irrelevance. But this particular patient was well prepared.

‘Backache,’ he said. ‘I’ve got severe pain in my back.’

I confess I was surprised.

He looked a fit young man to me, and he moved around with perfect ease, not like a man crippled by back pain.

Moreover, he had a number of cuts and bruises on him, the result of having been beaten up by a gang of children who had tried to mug him in the street and whom he had unwisely chased.

People with back pain are quite often mugged, of course, but they rarely run after their muggers.

Perhaps this man was emboldened by the fact that his hobby was martial arts: again, an odd choice of pastime for someone with incapacitating backache.

I telephoned his general practitioner with my suspicions, thinking that perhaps he had been deceived by his patient into signing him off sick.

I told the doctor my grounds for suspecting that his patient’s backache was not as bad as he claimed. It turned out, however, that I was telling the doctor nothing he did not already know.

‘Yes,’ he said, ‘he has never struck me as having been in much pain.’

‘But he has been off sick for the past year,’ I said, my voice tinged with outrage.

‘Yes,’ said the doctor, ‘but the last patient whom I made fit to work when he didn’t want to return to work picked up my computer and threw it at me. We ended up having a fight on the floor.’

I understood at once.

It isn’t only sick notes that are procured by threat, of course: round here all mind-altering substances – tranquillisers and antidepressants – are prescribed not for the patient’s sake but to forestall an attack on the doctor, who gives that patient whatever he wants to remove him from his presence as quickly as possible, before the patient spits at or punches him.

Things are a little better in the prison, I’m glad to say.

There the doctor is free to do what he thinks is best for the patient, thanks to the proximity of several very large men at his beck and call.

Last week, a patient arrived in the prison, a fit (though presumably not very skilful) young burglar.

‘Are you on any treatment?’ I asked him.

‘Yes,’ he said. ‘DF 118, diazzies and amitrippiline.’

An opiate analgesic, an addictive tranquilliser (diazepam) and an antidepressant (amitriptyline).

‘Why?’ I asked.

‘Backache,’ he replied.

‘Ah, a burglar with a backache.’ I said.

He smiled at me, and I smiled back.

Then we had a good chuckle together.

I knew, he knew I knew, I knew he knew I knew, and he knew I knew he knew I knew.

‘Nice one, Doctor,’ he said as he left the room, in excellent spirits.

British slang converter:

‘Sick notes’ – notes provided by a doctor to a patient excusing the patient from work and enabling him to claim statutory sick pay or other benefits.

Like this:

RECENTLY WHILE TRAVELLING on the London Underground, the opening words of Marx’s The Eighteenth Brumaire of Louis Bonaparte ran through my mind like a refrain:

Hegel remarks somewhere that all great world historic events and personages appear, so to speak, twice. He forgot to add: the first time as tragedy, the second time as farce.

Why, you might ask, did this passage insinuate itself into my brain on the District Line between West Brompton and Earl’s Court?

Standing opposite me was a young man badly dressed in black, on whose baseball cap was inscribed the word ‘Victim’.

On his black T-shirt were the words, ‘I wish I could be you’, which implied self-pity on an industrial scale.

On his right forearm (from which, Sherlock Holmes-like, I inferred he was left-handed) were a series of parallel scars from self-inflicted injury.

On his right forearm was tattooed a simplified reproduction of a picture by Gustav Klimt. All paintings appear twice: the first time as art, the second time as kitsch.

Reaching my destination, there was an announcement over the public address system. Because of the hot weather, it said, passengers are advised to carry a bottle of water with them while travelling, and passengers who felt unwell were advised to seek assistance.

Who, I wondered, would help me with my profound sense of irritation?

I was on my way to lunch with an old doctor friend. He was in a lather of indignation, as usual, against the administration and its Newspeak. He was particularly exercised by the term ‘quality assurance’, the locus standi of yet another layer of bureaucracy.

‘The problem is,’ he said, ‘that no one can be against quality.’

Then we started to utter slogans by turns.

‘Down with quality!’

‘Down with equity!’

‘Down with easy access!’

‘Down with world-class!’

‘Fewer patients, more paperwork!’

‘Shorter consultations, longer lunches!’

The other customers in the restaurant of the Royal Academy – for that is where we were – must have thought we were lunatics with delusions of medical qualifications who had been let out for the day.

Later that afternoon, I waited for my wife at a pub near a well-known railway station. It was pleasant to sit outside with a drink, even if most of the other drinkers had shaven heads or pony-tails, or (in one case) both. The only woman around, before my wife arrived, was also a man.

He was clearly in the throes of the sex change, for he dressed like a woman, and had breasts, but spoke and behaved like a man.

I wouldn’t have mentioned this had he not spoken so volubly about something called a ‘gender assignment certificate’.

Here indeed is a new field for bureaucracy to till. I suggest such certificates be made compulsory, like identity cards. There will be errors, of course, but such is the cost of progress.

I accidentally knocked an empty plastic bottle off my table and it fell at the feet of another drinker. I bent down to pick it up. ‘I wouldn’t bother if I were you,’ he said.

‘But you’re not me,’ I replied.

And then I thought of the man on the District Line: ‘I wish I could be you.’

Then I wouldn’t mind wading through rubbish as I walked down the street.

Like this:

SCRATCH THE SURFACE and there is always tragedy, mixed, of course, with wickedness.

Because of the economic crisis, I was waiting at the bus station: £2.80 for a bus instead of £28 for a taxi home.

I had fifty minutes to wait and was reading a book by Richard Yates. I was wondering why the literature of so optimistic a country as America was so deeply pessimistic (awareness of death is the answer, of the bust after the boom of life from which there is no upturn), when a lady in her eighties sat down beside me.

She was tired. Her cheeks puffed and her lips pouted as one with chronic obstructive pulmonary disease.

‘I prefer to take taxis,’ she said to me, ‘but I took one yesterday and I can’t do it all the time. I’ve got a little in the bank, but you never know how long you’ll last.’

These days, you don’t know how long the bank will last, either, but I didn’t say that.

She told me the story of her daughter, aged 44, whose consort, aged 57, had died of cancer a couple of months ago.

‘He was perfectly fine until last Christmas, then he wasted away and he was like a little old man by the time he died. He was a lovely feller.’

Her daughter hadn’t bothered to get divorced from her first husband until it was clear that her consort, with whom she had lived ten years out of wedlock, was dying.

She finally got her divorce, and shortly before his death asked the registrar to marry them at home, he on his deathbed.

‘The registrar telephoned her and said I’m sorry to have to tell you that there’s been an objection to the marriage. I’m not allowed to tell you who it was.’

But it was obvious: it was his former wife and their children, who were worried about the inheritance. They went round to the dying man’s house two days before he died and created such a disturbance that the police had to be called, but they left before the arrival of the police. They had learnt that their objection to the marriage had made no difference, since he had long ago changed his will. Their parting words to the old lady’s daughter as they left were, ‘Enjoy your little house.’ They were still making trouble.

The old lady caught a bus before mine, and a respectable old couple came and sat beside me. We were soon joined by a drunk in his late thirties, his clothes filthy.

His face had obviously kept many casualty departments busy in the past, and he had a cut with stitches over his left eyebrow.

Swaying and lurching towards the old couple, he asked them where his bus-stop was.

‘That depends,’ said the woman gently, ‘where you’re going.’

This came to him with the force of revelation. He propped himself up against the glass of the bus-shelter and slid slowly down it on to his haunches.

‘I’ll have to think about it, ‘ he said. ‘Wait a bit.’

I thought of a line of Gloucester’s in Lear and adapted it in my mind: I have no way, and therefore want no bus.

If it is possible to crawl to your feet, he did so.

‘Want to hear a joke?’ he asked. ‘What do you call a rabbit with a bent dick?’

This was clearly a question that the old couple had not previously considered.

‘A rabbit with a bent dick,’ he said.

The bus arrived, he didn’t get on it, and soon we were speeding along the literal darkness of the country lanes, instead of lingering in the metaphorical urban darkness.

Like this:

WHY DO PEOPLE do the things they do, especially when they are so bad for them? A patient of mine last week offered me the complete explanation, when I asked him why he had taken heroin for the last eight years, with the exception of the time he had spent in prison.

‘Everyone does it,’ he said.

‘I don’t,’ I said.

‘Everyone I know.’

So there you have it: in this age of unbridled self-expression, when (to quote our esteemed Minister of Education) the three Cs, culture, creativity and community – or is it compassion, caring and crying in public? – have replaced the three Rs, everyone does what everyone else does.

But things are not quite as bleak as they seem; there is more variation than at first sight appears.

‘Do you have brothers and sisters?’ I asked

‘Yes, two brothers and two sisters.’

‘Do any of them take heroin?’

‘No,’ he replied.

‘So it’s not quite true, then, that everyone you know takes heroin?’

Suffice it to say that he did not greet my exposure of the contradiction between what he said and the truth with the pleasure that a disinterested searcher after knowledge might have expressed.

‘I’ve been trying to give up for years,’ he said. ‘But it’s everywhere.’

Then he uttered the heartfelt cry of despair that thousands of middle-class housewives since time immemorial have uttered.

‘I just can’t get the help.’

I moved on. My next patient had spent the last 20 minutes chatting cheerfully on his mobile phone. Having made arrangements for the evening, he wore a complacent grin, and it surprised me to learn that the night before he had taken an overdose.

‘What did you take?’ I asked.

‘Temazzies,’ he said.

Temazzies belong to the same class of drugs as diazzies – and nitrazzies, lorazzies, bromazzies, flurazzies and oxazzies. You can tell that people love them by the fact that they give them a familiar name.

No one does this for, say, the vincristine that treats their leukaemia. And the property for which all the -azzies are so highly esteemed is their ability to dull the mind and empty it of thought: which is, after all, the great object of most English life, especially in its recreational phase.

If someone were to start a Society for the Prevention of Thought, he would swiftly make a fortune from the subscriptions.

I broke my vow never to use the argot of the streets.

‘Why did you take the temazzies?’ I asked.

‘This bloke gave them to me in the pub.’

‘But why did you take them?’

‘Well, what else was I supposed to do with them?’

‘But why? Did you know what they were?’

‘I’d seen him take them before. He took them regular, by the handful. They never did him no harm.’

‘But I still don’t quite understand why you took them.’

‘Well, I had alcohol in my head, didn’t I?’

I suppose every event must have a cause but when it comes to human conduct, not every action must have a reason.

‘Would you do it again?’ I asked.

‘It depends how I was feeling. And whether there was any temazzies about.’

For loving someone ‘to bits’ in modern British parlance connotes regular strangulation, either given or received. I leave it to marriage guidance counsellors to decide whether, in this context, it is more blessed to give or to receive.

Of course, the words ‘on my baby’s life’ are also pretty terrible, irresistibly conjuring up as they do images of Old Testament sacrifice; but, in fact, ‘on my baby’s life’ means only that everything that follows is an unadulterated lie.

Thus ‘On my baby’s life, doctor, I never touched her’ means ‘I beat her unconscious regularly and broke several bones in her body’.

It is also a fact that men who say ‘on my baby’s life’ always abandon their children in the end.

A man who both loved his girlfriend to bits and swore on his baby’s life that he hadn’t laid a finger on her took an overdose because she had left him. It seemed that he had smashed up the flat in which they lived and which he had just redecorated.

‘Every time I try to do something, doctor,’ he said, ‘it just explodes at me.’

‘And would you take another overdose, then?’ I asked.

‘Sod that, man,’ he said. ‘It’s caused too much pain in my head.’

He was a strangler, of course, though only an amateur by comparison with some I have met. In any case, a true strangler needs his strangulee, for as everyone knows it takes two to strangle. And, as it happens, there was a classic strangulee in the next bed.

She, too, had tried to kill herself with pills because she had had enough. The problem was that the strangler in her life kept telephoning, and each time she weakened and let him back into her house.

‘When he’s not strangling me,’ she said, ‘he’s very nice.’

‘How did you meet him?’ I asked.

‘In a pub.’

‘And how long had you known him before he moved in with you?’

‘A few hours.’

‘Has he a criminal record?’

‘Yes.’

‘Has he been to prison?’

‘Yes.’

‘What for?’

‘He was in eight years for murder. He ran over someone with his lorry.’

‘If I’ve understood you correctly, you met a murderer in a pub, you started to live with him a few hours later, and he has repeatedly half-strangled you.’

‘Yes, doctor.’

‘I hope you don’t mind me asking, but why do you stay with him?’

‘I love him to bits, doctor.’

I howled. I laughed. I wanted to bang my head on the wall and climb straight to the hospital roof and throw myself off. In the event, I merely clutched my head. She started to laugh.